Why We Can’t Punish Our Way Out of the Addiction Epidemic


September 5, 2018   Thomas G. Kimball, PhD

The addiction epidemic, including the current opioid crisis, has brought the level of addiction-related incarcerations and accidental drug overdoses to unprecedented new levels. The current state of affairs has created a great strain on the operating ability of state and federal criminal justice systems in America. Without effective changes in policy and practices, this strain could push state and federal institutions past their threshold and create unforeseen consequences beyond the scope of the current issues.

Unfortunately, the US government continues to spend money on harsh enforcement strategies with little funding going toward treatment, let alone on long-term recovery supports. According to the Federal Government, 23.5 million Americans need substance abuse treatment but only 10% actually receive it.[1] Many of these individuals who need treatment find themselves within the judicial system due to non-violent drug offenses.

Despite being the place where the “War on Drugs” started, the U.S. continues to have some of the highest drug use rates in the world.[2] By most every reasonable measure (e.g., finances, drug trafficking, drug use) the “War on Drugs” has been a complete and utter failure. We, as a society, must do better and must find new and creative ways to address the addiction epidemic and our current crisis—moving away from the ineffective incarceration of individuals who suffer from the chronic disease of addiction.

Incarceration does not reduce drug use

Not only is incarceration not effective in reducing drug use but the financial cost is extraordinary. The annual cost of incarceration for a federal inmate was estimated at $36,299.25 in 2017 and the number only climbs.[3] State annual incarceration amounts can be much higher. This financial cost does not account for the familial and societal costs of non-violent drug offenders who are capable of being treated and rehabilitated taken away from families and away from the workforce.

Improving long-term outcomes for those who suffer from addiction is of paramount importance. The intersection between the judicial system and treatment is critical to this effort. Historically, both the substance abuse treatment field and the judicial system have focused on a reduction of substance use. This focus on the short-term does little to make the recovery journey attractive over a lifetime.

Broadening the scope of recovery and treatment, current efforts must not only reduce initial use but also connect individuals to positive long-term reinforcement. Employment and education are two important opportunities that create a host of further positive incentives (e.g. financial wellbeing, positive identity development, etc.) to help sustain recovery efforts.[4] A connection to both employment and education must be utilized in both treatments and within the judicial system.

Drug Courts Could Be Utilized More Effectively

Although drug courts have been around for several decades, their continued and expansive use should be seen as a creative and effective way to help those who suffer from addiction find recovery within the judicial system. Comparison studies on drug courts have shown that they are an effective way to reduce recidivism. Completion studies of drug courts have found re-arrest rates 6-26% lower for program participants when compared to non-program participants. When narrowing the focus to program completers the numbers grew to 12-58% lower re-arrest rates for participants versus non-participants.[5]

Drug courts also may prove helpful in assisting drug court participants in becoming connected to the positive incentives that sustain recovery mentioned above. These incentives, most often employment, not only help to sustain the early gains of recovery but also increase the probability of extending recovery long-term.

Specific to the opioid crisis, opioid addiction is proving to be more complicated than other forms of addiction. Due to the difficulty of detoxification and also the chronic cravings, opioid-dependent sufferers who participate in drug courts may be at a higher risk to not only miss court dates due to relapse but also to die from accidental drug poisoning.

Drug Court Case Study: Rensselaer County, New York

One county has pursued grant funding and adopted programs wherein high risk, high need individuals are given a chance to find recovery with funding assistance provided for longer treatment (18-24 months) which includes participating in drug court. This program also works hard on finding those long-term incentives that promote better long-term recovery outcomes by helping individuals successfully reintegrate and reenter the workforce. All of this is done at a fraction of the cost of incarceration.

Through a grant provided by the Bureau of Judicial Assistance, a drug court in Rensselaer County New York uses awarded grant funds to help vulnerable non-violent individuals who suffer from opioid dependency. Given the difficult journey of those with opioid dependency, drug court Judge Debra Young helped to develop a system where jailed individuals seamlessly enter a higher level of care directly from jail.

The program lasts 18-24 months where individuals receive intense supervision, drug testing, and recovery supports. Forty people have benefited from the program thus far. Most everyone across the political spectrum is seeing the benefits. The county reports tremendous cost savings from $4000-$5000 dollars to participate in the drug court treatment program versus over $60,000 the state spends to incarcerate an individual during the same period of time. The results from Rensselaer County are highly encouraging.[6]

More Support, Less Punishment

During this time of increased awareness regarding the addiction epidemic as well as the opioid crisis, we are beginning to understand where our tax dollars really should be spent. This is particularly relevant for those who commit non-violent drug offenses who need treatment and extended support.

What is particularly important to note is that those who suffer from opioid use disorder may need specialized considerations. Any such model developed to help in this crisis should offer extended recovery supports where program participants are connected with long-term recovery incentives, such as employment and education. Moving toward a focus on more rehabilitation efforts and away from increased incarceration and punitive measures will not only improve outcomes for those suffering from addiction but also improve society as a whole by creating more productive people in the process.

References

[1]U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. (September 2010). Results from the 2010 National Survey on Drug Use and Health. p. 84
https://www.samhsa.gov/data/sites/default/files/NSDUHNationalFindingsResults2010-web/2k10ResultsRev/NSDUHresultsRev2010.pdf

[2] Degenhardt L, Chiu W-T, Sampson N, Kessler RC, Anthony JC, et al. (July 2008). Toward a Global View of Alcohol, Tobacco, Cannabis, and Cocaine Use: Findings from the WHO World Mental Health Surveys. PLoS Medicine. http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050141

[3] Federal Register (2018. Annual Determination of Average Cost of Incarceration. https://www.federalregister.gov/documents/2018/04/30/2018-09062/annual-determination-of-average-cost-of-incarceration

[4] McKay, J. R. (2016). Making the hard work of recovery more attractive for those with substance use disorders. Addiction, doi:10.1111/add.13502

[5] Adult Drug Courts: Studies Show Courts Reduce Recidivism, but DOJ Could Enhance Future Performance Measure Revision Efforts” (Washington, DC: Government Accountability Office, Dec. 2011), GAO-12-53, pp. 19-20. https://www.gao.gov/assets/590/586793.pdf

[6] Crowell, C (2018, May 29). Rensselaer County Drug Court Uses Grant to Give Opioid Addicts new start. Timesunion. https://www.timesunion.com/news/article/Rensselaer-County-Drug-Court-uses-grant-to-give-12949833.php


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